Bath County, Kentucky death certificate of Anna Henderson Bailey

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Date: Sun, 26 Jan 2003
Darrell Warner
From: http://www.genrecords.net/emailregistry/vols/00001.html#0000008
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BATH COUNTY, KENTUCKY DEATH CERTIFICATE
File number: 116 66 1823
Registrar's number: 5
Registration district number: 50
Primary registration district number: 4081
1. Place of death
  a. County: Bath
  b. City or town: Owingsville RR #1
  c. Length of stay: nothing listed
  d. Full name of hospital or institution: nothing listed
2. Usual residence
  a. State: Kentucky
  b. County: Bath
  c. City or town: Owingsville RR #1
  d. Street address: nothing listed
  e. Is residence on a farm: yes
  f. Is residence inside city limits: no
3. Name of deceased:
  a. First: Anna
  b. Middle: Henderson (this is her maiden name)
  c. Last: Bailey
4. date of death: January 19, 1966
5. Sex: female
6. Color or race: white
7. Married, never married, widowed or divorced: widowed
8. date of birth: August 22, 1891
9. Age: 74 years
10a. Usual occupation: nothing listed
10b. Kind of business or industry: nothing listed
11. Birthplace: Bath County, Kentucky
12. Citizen of what country: USA
13. Father's name: Robert Henderson
14. Mother's maiden name: Margaret Holland
15. Was deceased ever in U.S. Armed Forces: no
16. Social security number: nothing listed
17. Informant: Mrs. Lester Gray of Owingsville RR #1
18. Cause of death
  a. Death was caused by Coronary occlusion
  b. Due to arteriosclerotic heart disease
  c. Due to; nothing listed
  d. Other significant conditions contributing to death but not related to the terminal disease condition given in part a: severe acute influenza
19. Was autopsy performed: no
20. Accident, suicide, or homicide: nothing listed
21. Time of injury, place of accident: nothing listed
22. I hereby certify that I attended the deceased from 1946 to 1-19-1966, that I last saw the deceased alive on 1-19-1966, and that the death occurred at 8:00 PM from the causes and on the date stated above.
23a. Date signed: 1-24-1966
23b. Address: Owingsville, Kentucky
23c. Signature: Robin A. Byrum MD
24a. Burial, cremation or removal: burial
24b. Date: January 22, 1966
24c. Name of cemetery: Longview Cemetery
24d. Location of cemetery: Bethel, Kentucky
25a. Date received by local registrar: 2-21-1966
25b. Registrar's signature: Lena R. Brooks
26. Funeral director: Fred Keal, Keal Funeral Home, Owingsville, Kentucky